Hospital revisits within 30 days after conventional and robotically assisted hysterectomy

Bernard Friedman, Gabriel I. Barbash, Sharon Glied, Claudia A. Steiner

Research output: Contribution to journalArticle

Abstract

Objectives: To compare the rates of hospital readmissions, emergency department, and outpatient clinic visits after discharge for robotically assisted (RA) versus nonrobotic hysterectomy in women age 30 or more with nonmalignant conditions. Data Sources: Discharges for 2011 for 8 states (CA, FL, GA, IA, MO, NE, NY, TN) (> 86,000 inpatient hysterectomies) were drawn from the statewide databases of the Healthcare Cost and Utilization Project. Data from 4 of these states were used to study revisits after 29,000 outpatient hysterectomies. Methods: Matched pairs of patients were constructed with propensity scores derived from each patient's age group, severity of illness, insurance coverage, and type of procedure. Both the full set of revisits and a set limited to diagnoses for revisits judged in other research to be related to the initial surgery (about 70% of all revisits) were analyzed. The analyses were repeated with an instrumental variables regression design. Key Results: Using the propensity score matched pairs, revisits, and specifically readmissions, after inpatient hysterectomy were greater for RA versus non-RA patients (relative risk of readmission = 124%, P < 0.01). Similar results were found for readmissions after outpatient hysterectomy, and readmissions after inpatient hysterectomy for the restricted set of related revisits. In the method with instrumental variables, RA was associated with an increase of 32% in the likelihood of any revisit (P < 0.01). Conclusions: Using 2 different methods to control for selection, this study found higher rates of revisits among women undergoing RA versus non-RA hysterectomy for benign conditions. While selection bias cannot be ruled out completely in an observational study, the study supports broader use of revisits for analyses of outcomes of hysterectomy.

Original languageEnglish (US)
Pages (from-to)311-318
Number of pages8
JournalMedical Care
Volume54
Issue number3
DOIs
StatePublished - 2016

Fingerprint

Hysterectomy
Inpatients
Propensity Score
Outpatients
Patient Readmission
Insurance Coverage
Selection Bias
Information Storage and Retrieval
Ambulatory Care
Ambulatory Care Facilities
Health Care Costs
Observational Studies
Hospital Emergency Service
Age Groups
Databases
Research

Keywords

  • Hospital revisits
  • Robotic Hysterectomy

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Medicine(all)

Cite this

Hospital revisits within 30 days after conventional and robotically assisted hysterectomy. / Friedman, Bernard; Barbash, Gabriel I.; Glied, Sharon; Steiner, Claudia A.

In: Medical Care, Vol. 54, No. 3, 2016, p. 311-318.

Research output: Contribution to journalArticle

Friedman, Bernard ; Barbash, Gabriel I. ; Glied, Sharon ; Steiner, Claudia A. / Hospital revisits within 30 days after conventional and robotically assisted hysterectomy. In: Medical Care. 2016 ; Vol. 54, No. 3. pp. 311-318.
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